Provider First Line Business Practice Location Address:
1 LUCINDA AVENUE
Provider Second Line Business Practice Location Address:
NORTHERN ILLINOIS UNIVERSITY
Provider Business Practice Location Address City Name:
DEKALB
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-753-1481
Provider Business Practice Location Address Fax Number:
815-753-1664
Provider Enumeration Date:
01/17/2007